5 In one study, the association of VP with benign (osteoporotic) vertebral fractures seemed so clear that the authors even suggested that the presence of this sign might be used as a rationale to avoid a biopsy or additional radiologic studies among patients with suspected malignancies.
VP in an intervertebral disk is the classic form that is most frequently associated with degenerative disease of the spine.2 The second most common event associated with intervertebral disk VP is vertebral collapse.
The VP as described in radiologist protocols can be classified into 3 forms: VP in an intervertebral disk, VP in a vertebra, and VP in the spinal canal. One widely known example with a similar effect, when dissolved gas returns to gasiform state, is the rotation of the propeller of a powerboat it causes the pressure cavitation effect that leads to the formation of air bubbles. This gas is predominantly the nitrogen (90%-92%). This drop in pressure in a closed space of the intervertebral disk leads to a suction effect that causes the redistribution of the least-soluble gas dissolved in surrounded tissue inside the disk. With general activity, the pressure in the disk between vertebrae shifts: It increases when vertebrae move closer to each other and decreases when vertebrae move away from each other. The name of the radiologic sign vacuum phenomenon reflects the pathogenesis of the finding. 3 Given this association, recognition of this sign in radiologist protocols, understanding the pathogenesis of the finding, and reasonable comparison with clinical data could lead to better outcomes in patient care by encouraging further investigation. While “vacuum disk” findings are mostly associated with degenerative disk changes or benign vertebral collapse, the sign might be important due to the association with various underlying medical conditions including spinal infection with gas production. 1 The prevalence of that sign based on plain spinal images varies from 1% to 3% in the general population to 20% among elderly individuals. This unique finding was first described more than 80 years ago. In the spine, VP reflects a radiologic symptom of the gaseous collection in an intervertebral disk or in the spinal vertebra itself. The arrows indicate the area of translucency in all intervertebral disks from L1 to S1 vertebrae, consistent with the vacuum phenomenon.ĭiscussion. Abdominal CT reconstructions in sagittal (A) and coronal (B) planes of an 81-year-old woman.
We have noticed that many internists are not familiar with the interpretation of this finding and its clinical correlation.įigure. The patient was treated successfully with intravenous antibiotics and was discharged, with follow-up scheduled in the clinic.ĭuring the initial workup in the ED, computed tomography (CT) of the abdomen and pelvis revealed mild right hydroureteronephrosis with no visible stone or obstructing lesion, as well as vacuum phenomena (VP) in the intervertebral disks on the levels L1 through S1 ( Figure). Urinalysis results were suggestive of a urinary tract infection the blood urea nitrogen level was elevated to 45 mg/dL and the creatinine level was elevated to 1.6 mg/dL. Physical examination revealed mild to moderate right costovertebral angle tenderness. The patient had a history of chronic lower back pain. Consultant. 2019 59(8):254-255.Īn 81-year-old woman with a history of type 2 diabetes mellitus and degenerative joint disease was referred to our emergency department (ED) with nausea, intermittent moderate abdominal pain, and bilious vomiting. Department of Medicine, NYC Health + Hospitals/Metropolitan, New York, New Yorkĭrozdov A, Chaudhari S.
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